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  • Affects 6%–9% of school-aged children.

Evaluation and Diagnosis

  • Multiple components are involved in appropriate evaluation and diagnosis (Pediatrics 2000;105(5):1158).
  • The PCP should consider ADHD in any child age 6–12 yr with:
    • Inability to sit still or hyperactivity
    • Lack of attention, poor concentration, or frequent daydreaming
    • Impulsiveness
    • Behavior problems
    • Poor academic achievement
  • Assessment for ADHD by the pediatrician should include a complete history, complete physical examination (including thorough neurologic examination), family assessment, and school assessment.

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Evidence directly obtained from parents and teachers:
  • Core symptoms in 2 or more settings
  • Age of onset
  • Duration of symptoms
  • Degree of functional impairment
  • When available:
  • School-based multidisciplinary evaluations

Pediatrics 2000;105(5):1158.

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Documentation (via interview or ADHD-specific checklists) of:
  • Hyperactivity
  • Impulsivity
  • Inattention
  • Documentation must include:
  • Age of onset
  • Duration
  • Multiple settings and circumstances
  • Degree of impairment

Reproduced with permission from Pediatrics 2000;105(5):1158.

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Documentation of elements of inattention, hyperactivity, impulsivity

Use of teacher-specific ADHD checklist (short form preferred)

Teacher narrative:

  • Degree of functional impairment
  • Classroom behavior and interventions
  • Learning patterns

Evidence of school performance:

  • Report card
  • Samples of school work

Reproduced with permission from Pediatrics 2000;105(5):1158.

  • Additional testing generally is not necessary for the diagnosis of ADHD/ADD (lead screening, thyroid screening, EEG, brain imaging), particularly when the medical history is unremarkable.
  • Psychological and neuropsychological testing is not required but should be performed if the history is suggestive of low cognitive ability or low achievement in language or studies relative to intellectual ability.
  • Use of formal parent and teacher rating scales (eg, Conners scale, Vanderbilt scale; available at is an option to assist in the evaluation or diagnosis of ADHD; if used, the short forms are recommended. Repeated serial administration of these scales at follow-up may provide additional helpful data on response to interventions.
  • The diagnosis of ADHD/ADD requires that DSM-IV criteria are met (see below).
  • Comorbid conditions must be considered and addressed. Up to one in three children has a significant comorbid condition, and many children have multiple comorbidities:
    • Learning disorders (one in eight children with ADHD/ADD meet criteria) or language disorders
    • Oppositional defiant disorder (one in three)
    • Conduct disorder (one in four)
    • Anxiety disorder (one in four)
    • Depression disorder (one in five)

Diagnostic Criteria for ADHD: DSM-IV Criteria

(Pediatrics 2000;105(5):1158)

Must meet each of the following criteria (A through E):

A. Must meet 6+ criteria under either of the following two subtypes:

Inattentive Criteria

6+ of the following symptoms of inattention persisting for 6 mo and are maladaptive and inconsistent with developmental level:

  1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities


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